Disseminated nocardiosis involving lung, liver, and spleen in a patient with intestinal Behçet's disease under combined immunosuppressive therapy.

We report a rare case of disseminated nocardiosis in a woman in her 50 s with a 20-year history of intestinal Behçet's disease who had been receiving infliximab, azathioprine, and oral betamethasone. She developed fever and sore throat 6 weeks after infliximab administration. Laboratory findings revealed leukocytosis, elevated liver enzymes, and markedly increased C-reactive protein and procalcitonin. Contrast-enhanced computed tomography revealed multiple nodular lesions in both lungs and multiple abscesses in the liver and spleen. Blood cultures identified Nocardia species, and a diagnosis of disseminated nocardiosis was established. Initial treatment with trimethoprim-sulfamethoxazole was discontinued because of drug-induced pancreatitis. The regimen was switched to imipenem/cilastatin, followed by minocycline, resulting in complete abscess resolution. A literature review identified three similar cases with lung, liver, and splenic abscesses, all with significant T-cell-related immunosuppression. This case highlights the risk of disseminated Nocardia infection in patients receiving combined immunosuppressive therapy, including biologics, and highlights the importance of early diagnosis and adaptable antimicrobial management in immunocompromised hosts.